Skip to main content
Top
Published in: European Radiology 6/2018

01-06-2018 | Radiological Education

Computed tomography use in a large Italian region: trend analysis 2004-2014 of emergency and outpatient CT examinations in children and adults

Authors: Andrea Pola, Daniela Corbella, Andrea Righini, Alberto Torresin, Paola E. Colombo, Luigi Vismara, Luca Trombetta, Michele Maddalo, Maria Vittoria Introini, Daniela Tinelli, Laura Strohmenger, Giovanna Garattini, Angelica Munari, Fabio Triulzi

Published in: European Radiology | Issue 6/2018

Login to get access

Abstract

Objectives

To analyse CT use in recent years in a high-density Italian area (±10 million inhabitants, including 1 million children), focusing on developing age.

Methods

Retrospective analysis of records from HealthCare IT System, covering >400 hospitals and clinics. Description of CT use between 2004–2014 in emergency and outpatient care and assessment of radiation exposure trend.

Results

Over 9 million scans were performed. Emergency procedures showed a global increase of 230 %, mainly head examinations. In the global outpatient setting, the annual number of CT scans/person increased ±19 %. A moderate increase in CT examinations was observed in the developing age population, while a remarkable increase in dental, chest and abdominal procedures occurred for the 10- to 30-year age range. The increase in mean annual dose/capita in the global patient pool was approximately 42 %, increasing from 0.72–1.03 mSv. The population rate receiving an annual CT radiation dose/capita higher than 1 mSv tripled in the 11-year interval, increasing from 16–48 %.

Conclusions

The remarkable increase in radiation exposure raises a special concern for teenagers and young adults, whose risk tends to be underestimated. The fivefold increase in dental CTs in the younger age groups requires further investigations.

Key Points

• Literature highlights a remarkable increase in CT use over the last decades.
• The paediatric age had higher exposure to X-ray risk.
• A detailed retrospective analysis of more than 9 million scans was performed.
• Dental, chest, abdominal procedures increased remarkably in 10- to 30-year age range.
• This study raises concern about exposure for teenagers and young adults.
Appendix
Available only for authorised users
Literature
1.
go back to reference Shannoun F, Zheeb H, Back C, Blettner M (2006) Medical exposure of the population from diagnostic use of ionizing radiation in Luxembourg between 1994 and 2002. Health Phys 91:154–162CrossRefPubMed Shannoun F, Zheeb H, Back C, Blettner M (2006) Medical exposure of the population from diagnostic use of ionizing radiation in Luxembourg between 1994 and 2002. Health Phys 91:154–162CrossRefPubMed
2.
go back to reference Brenner DJ, Hall EJ (2007) Computed tomography – An increasing source of radiation exposure. N Engl J Med 357:2277–2284CrossRefPubMed Brenner DJ, Hall EJ (2007) Computed tomography – An increasing source of radiation exposure. N Engl J Med 357:2277–2284CrossRefPubMed
3.
go back to reference Borretzen I, Lysdahl KB, Olerud HM (2007) Diagnostic radiology in Norway trends in examination frequency and collective effective dose. Radiat Prot Dosim 124:339–347CrossRef Borretzen I, Lysdahl KB, Olerud HM (2007) Diagnostic radiology in Norway trends in examination frequency and collective effective dose. Radiat Prot Dosim 124:339–347CrossRef
5.
go back to reference Catuzzo P, Aimonetto S, Zenone F et al (2010) Population exposure to ionizing radiation from CT examinations in Aosta Valley between 2001 and 2008. Br J Radiol 83:1042–1051CrossRefPubMedPubMedCentral Catuzzo P, Aimonetto S, Zenone F et al (2010) Population exposure to ionizing radiation from CT examinations in Aosta Valley between 2001 and 2008. Br J Radiol 83:1042–1051CrossRefPubMedPubMedCentral
6.
go back to reference Muhogora WE, Ahmed NA, Alsuwaidi JS et al (2010) Paediatric CT examinations in 19 developing countries: frequency and radiation dose. Radiat Prot Dosim 140:49–58CrossRef Muhogora WE, Ahmed NA, Alsuwaidi JS et al (2010) Paediatric CT examinations in 19 developing countries: frequency and radiation dose. Radiat Prot Dosim 140:49–58CrossRef
7.
go back to reference Kocher KE, Meurer WJ, Fazel R, Scott PA, Krumholz HM, Nallamothu BK (2011) National trends in use of computed tomography in the emergency department. Ann Emerg Med 58:452–462CrossRefPubMed Kocher KE, Meurer WJ, Fazel R, Scott PA, Krumholz HM, Nallamothu BK (2011) National trends in use of computed tomography in the emergency department. Ann Emerg Med 58:452–462CrossRefPubMed
8.
9.
go back to reference Guite KM, Hinshaw JL, Ranallo FN, Lindstrom MJ, Lee FT Jr (2011) Ionizing radiation in abdominal CT: unindicated multiphase scans are an important source of medically unnecessary exposure. J Am Coll Radiol 8:756–761CrossRefPubMedPubMedCentral Guite KM, Hinshaw JL, Ranallo FN, Lindstrom MJ, Lee FT Jr (2011) Ionizing radiation in abdominal CT: unindicated multiphase scans are an important source of medically unnecessary exposure. J Am Coll Radiol 8:756–761CrossRefPubMedPubMedCentral
10.
go back to reference Bernier M-O, Rehel JL, Brisse HJ et al (2012) Radiation exposure from CT in early childhood: a French large-scale multicenter study. Br J Radiol 85:53–60CrossRefPubMedPubMedCentral Bernier M-O, Rehel JL, Brisse HJ et al (2012) Radiation exposure from CT in early childhood: a French large-scale multicenter study. Br J Radiol 85:53–60CrossRefPubMedPubMedCentral
11.
go back to reference Samara ET, Aroua A, Bochud FO et al (2012) Exposure of the Swiss population by medical x-rays: 2008 review. Health Phys 102(3):263–270CrossRefPubMed Samara ET, Aroua A, Bochud FO et al (2012) Exposure of the Swiss population by medical x-rays: 2008 review. Health Phys 102(3):263–270CrossRefPubMed
12.
go back to reference Smith-Bindman R, Miglioretti DL, Johnson E et al (2012) Use of diagnostic imaging studies and associated radiation exposure for patients enrolled in large integrated health care systems, 1996-2010. JAMA 307:2400–2409CrossRefPubMed Smith-Bindman R, Miglioretti DL, Johnson E et al (2012) Use of diagnostic imaging studies and associated radiation exposure for patients enrolled in large integrated health care systems, 1996-2010. JAMA 307:2400–2409CrossRefPubMed
14.
go back to reference Hayton A, Wallace A, Marks P, Edmonds K, Tingey D, Johnston P (2013) Australian per caput dose from diagnostic imaging and nuclear medicine. Radiat Prot Dosim 156:445–450CrossRef Hayton A, Wallace A, Marks P, Edmonds K, Tingey D, Johnston P (2013) Australian per caput dose from diagnostic imaging and nuclear medicine. Radiat Prot Dosim 156:445–450CrossRef
15.
go back to reference Etard C, Aubert B, Mezzarobba M, Bernier MO (2014) Exposure of the French paediatric population to ionizing radiation from diagnostic medical procedures in 2010. Pediatr radiol 44:1588–1594CrossRefPubMed Etard C, Aubert B, Mezzarobba M, Bernier MO (2014) Exposure of the French paediatric population to ionizing radiation from diagnostic medical procedures in 2010. Pediatr radiol 44:1588–1594CrossRefPubMed
20.
go back to reference International Commission on Radiological Protection (2007) Radiological protection in medicine, 105. Annals of the ICRP 37(6):1–332CrossRef International Commission on Radiological Protection (2007) Radiological protection in medicine, 105. Annals of the ICRP 37(6):1–332CrossRef
21.
go back to reference Committee on the Biological Effects of Ionizing Radiation (2006) Health Risks from Exposure to low Levels of Ionizing Radiation (BEIR VII), National Academy of Sciences, National Research Council. National Academy Press, Washington Committee on the Biological Effects of Ionizing Radiation (2006) Health Risks from Exposure to low Levels of Ionizing Radiation (BEIR VII), National Academy of Sciences, National Research Council. National Academy Press, Washington
22.
go back to reference Pearce MS, Salotti JA, Little MP et al (2012) Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study. Lancet 380(9840):499–505CrossRefPubMedPubMedCentral Pearce MS, Salotti JA, Little MP et al (2012) Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study. Lancet 380(9840):499–505CrossRefPubMedPubMedCentral
24.
go back to reference Berrington de Gonzalez A, Darby S (2004) Risk of cancer from diagnostic X-rays: estimates for UK and 14 other countries. Lancet 363:345–351CrossRefPubMed Berrington de Gonzalez A, Darby S (2004) Risk of cancer from diagnostic X-rays: estimates for UK and 14 other countries. Lancet 363:345–351CrossRefPubMed
25.
go back to reference Brenner DJ, Elliston C, Hall E, Berdon W (2001) Estimated risks of radiation-induced fatal cancer from pediatric CT. AJR Am J Roentgenol 176:289–296CrossRefPubMed Brenner DJ, Elliston C, Hall E, Berdon W (2001) Estimated risks of radiation-induced fatal cancer from pediatric CT. AJR Am J Roentgenol 176:289–296CrossRefPubMed
26.
go back to reference Krille L, Zeeb H, Jahnen A et al (2012) Computed tomographies and cancer risk in children: a literature overwiev of CT practices, risk estimations and an epidemiologic cohort study proposal. Radiat Environ Biophys 51:103–111CrossRefPubMed Krille L, Zeeb H, Jahnen A et al (2012) Computed tomographies and cancer risk in children: a literature overwiev of CT practices, risk estimations and an epidemiologic cohort study proposal. Radiat Environ Biophys 51:103–111CrossRefPubMed
27.
go back to reference Brady Z, Cain TM, Johnston PN (2011) Paediatric CT imaging trends in Australia. J Med Imaging Radiat Oncol 55:132–142CrossRefPubMed Brady Z, Cain TM, Johnston PN (2011) Paediatric CT imaging trends in Australia. J Med Imaging Radiat Oncol 55:132–142CrossRefPubMed
28.
go back to reference Pearce MS, Salotti JA, Howe NL et al (2012) CT scans in young people in Great Britain: temporal and descriptive patterns, 1993-2002. Radiol Res Pract 2012:1–8CrossRef Pearce MS, Salotti JA, Howe NL et al (2012) CT scans in young people in Great Britain: temporal and descriptive patterns, 1993-2002. Radiol Res Pract 2012:1–8CrossRef
29.
go back to reference Menoch MJ, Hirsh ADA, Khan NS, Simon HK, Sturm JJ (2012) Trends in computed tomography utilization in the pediatric emergency department. Pediatrics 129:e690–e697CrossRefPubMed Menoch MJ, Hirsh ADA, Khan NS, Simon HK, Sturm JJ (2012) Trends in computed tomography utilization in the pediatric emergency department. Pediatrics 129:e690–e697CrossRefPubMed
30.
go back to reference Palorini F, Origgi D, Granata C, Matranga D, Salerno S (2013) Adult exposures from MDCT including multiphase studies: first Italian nationwide survey. Eur Radiol. 44:469–483 Palorini F, Origgi D, Granata C, Matranga D, Salerno S (2013) Adult exposures from MDCT including multiphase studies: first Italian nationwide survey. Eur Radiol. 44:469–483
32.
go back to reference International Commission on Radiological Protection (2008) Radiological Protection in Medicine. Pubblication 105. Elsevier, Oxford International Commission on Radiological Protection (2008) Radiological Protection in Medicine. Pubblication 105. Elsevier, Oxford
33.
go back to reference International Commission on Radiological Protection (2008) Recommendations of the ICRP, Publication 103. Elsevier, Oxford International Commission on Radiological Protection (2008) Recommendations of the ICRP, Publication 103. Elsevier, Oxford
34.
go back to reference European Commission (2001) Referral Guidelines for Imaging, Radiation Protection 118. Office for Official Publications of the European Communities, Luxembourg European Commission (2001) Referral Guidelines for Imaging, Radiation Protection 118. Office for Official Publications of the European Communities, Luxembourg
36.
go back to reference Malone J, Guleria R, Craven C et al (2012) Justification of diagnostic medical exposures: some practical issues. Report of an International Atomic Energy Agency Consultation. Br J Radiol 85:523–538CrossRefPubMedPubMedCentral Malone J, Guleria R, Craven C et al (2012) Justification of diagnostic medical exposures: some practical issues. Report of an International Atomic Energy Agency Consultation. Br J Radiol 85:523–538CrossRefPubMedPubMedCentral
37.
39.
40.
go back to reference O’Sullivan J, O’Connor OJ, O’Regan K et al (2010) An assessment of medical students awareness of radiation exposures associated with diagnostic imaging investigations. Insights Imaging 1:86–92CrossRefPubMedPubMedCentral O’Sullivan J, O’Connor OJ, O’Regan K et al (2010) An assessment of medical students awareness of radiation exposures associated with diagnostic imaging investigations. Insights Imaging 1:86–92CrossRefPubMedPubMedCentral
41.
go back to reference Lee C, Haims AH, Monico EP, Brink JA, Forman HP (2004) Diagnostic CT scans: assessment of patient, physician, and radiologist awareness of radiation dose and possible risks. Radiology 231:393–398CrossRefPubMed Lee C, Haims AH, Monico EP, Brink JA, Forman HP (2004) Diagnostic CT scans: assessment of patient, physician, and radiologist awareness of radiation dose and possible risks. Radiology 231:393–398CrossRefPubMed
42.
go back to reference Thomas KE, Parnell-Parmley JE, Haidar S et al (2006) Assessment of radiation dose awareness among pediatricians. Paediatr Radiol 36:823–832CrossRef Thomas KE, Parnell-Parmley JE, Haidar S et al (2006) Assessment of radiation dose awareness among pediatricians. Paediatr Radiol 36:823–832CrossRef
43.
go back to reference Heyer CM, Hansmann J, Peters SA, Lemburg SP (2010) Paediatricians awareness of radiation dose and inherent risk in chest imaging studies- A questionnaire study. Eur J Radiol 76:288–293CrossRefPubMed Heyer CM, Hansmann J, Peters SA, Lemburg SP (2010) Paediatricians awareness of radiation dose and inherent risk in chest imaging studies- A questionnaire study. Eur J Radiol 76:288–293CrossRefPubMed
44.
go back to reference Shiralkar S, Rennie A, Snow M, Galland RB, Lewis MH, Gower-Thomas K (2003) Doctors’ knowledge of radiation exposure: questionnaire study. BMJ 327:371–372CrossRefPubMedPubMedCentral Shiralkar S, Rennie A, Snow M, Galland RB, Lewis MH, Gower-Thomas K (2003) Doctors’ knowledge of radiation exposure: questionnaire study. BMJ 327:371–372CrossRefPubMedPubMedCentral
45.
go back to reference Jacob K, Vivian G, Steel JR (2004) X-ray dose training: are we exposed to enough? Clin Radiol 59:928–934CrossRefPubMed Jacob K, Vivian G, Steel JR (2004) X-ray dose training: are we exposed to enough? Clin Radiol 59:928–934CrossRefPubMed
46.
go back to reference Arslanoglu A, Bilgin S, Kubal Z, Ceyhan MN, Ilhan MN, Maral I (2007) Doctors and intern doctors’ knowledge about patients’ ionizing radiation exposure doses during common radiological examinations. Diagn Interv Radiol 13:53–55PubMed Arslanoglu A, Bilgin S, Kubal Z, Ceyhan MN, Ilhan MN, Maral I (2007) Doctors and intern doctors’ knowledge about patients’ ionizing radiation exposure doses during common radiological examinations. Diagn Interv Radiol 13:53–55PubMed
47.
go back to reference Bautista AB, Burgos A, Nickel BJ et al (2009) Do clinicians use the American College of Radiology Appropriateness Criteria in the Management of their patients? AJR Am J Roentgenol 192:1581–1585CrossRefPubMed Bautista AB, Burgos A, Nickel BJ et al (2009) Do clinicians use the American College of Radiology Appropriateness Criteria in the Management of their patients? AJR Am J Roentgenol 192:1581–1585CrossRefPubMed
48.
go back to reference Soye JA, Paterson A (2008) A survey of awareness of radiation dose among health professionals in Northern Ireland. Br J Radiol 81:725–729CrossRefPubMed Soye JA, Paterson A (2008) A survey of awareness of radiation dose among health professionals in Northern Ireland. Br J Radiol 81:725–729CrossRefPubMed
49.
go back to reference Picano E (2004) Informed consent and communication of risk from radiological and nuclear medicine examinations: how to escape from a communication inferno. BMJ 329:849–851CrossRefPubMedPubMedCentral Picano E (2004) Informed consent and communication of risk from radiological and nuclear medicine examinations: how to escape from a communication inferno. BMJ 329:849–851CrossRefPubMedPubMedCentral
Metadata
Title
Computed tomography use in a large Italian region: trend analysis 2004-2014 of emergency and outpatient CT examinations in children and adults
Authors
Andrea Pola
Daniela Corbella
Andrea Righini
Alberto Torresin
Paola E. Colombo
Luigi Vismara
Luca Trombetta
Michele Maddalo
Maria Vittoria Introini
Daniela Tinelli
Laura Strohmenger
Giovanna Garattini
Angelica Munari
Fabio Triulzi
Publication date
01-06-2018
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 6/2018
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-017-5225-x

Other articles of this Issue 6/2018

European Radiology 6/2018 Go to the issue